Did drug availability in Malawian central hospitals improve after the conversion of central medical stores to a trust

Abstract

Malawian public hospitals have reportedly been experiencing a lot of shortages in medicines and medical supplies in recent years. This was at least in part, attributed to the traditional placement of the drug supply system under the Ministry of Health, and therefore a change in the organizational set-up was implemented in 2011. This study aimed at finding out if the availability of medicines in central hospitals in Malawi improved after the change of Central Medical Stores (CMS) to a Trust (CMST). A retrospective cohort study was done to quantify the availability of selected essential medicines before and after the change of CMS from stock cards. A questionnaire was filled by 23 health professionals to assess their views on whether the change of CMST resulted in improved availability of medicines. The study was done at Queen Elizabeth Central Hospital (QECH), Kamuzu Central Hospital (KCH) and Central Medical Store Trust. The targeted study period was before the change of CMS (2010/2011) and after (2013/2014) the change to CMST. The results of the study showed considerable reduction in stock-out days for both KCH and the CMST (from an average of 80 and 16 days to 42 and 9 days, respectively), with CMST results being statistically significant (p=0.023). However, in QECH, there was no improvement (from 22 to 24 days). The view of most respondents was that there was no improvement in medicine availability after the change of CMS, which represented a certain contradiction to the results of the quantitative part. This may be attributed to the fact that the questionnaire targeted only participants from QECH and KCH and left out participants from CMST. The study indicated that the radical shift in the management of CMS was followed by an improvement of drug availability in CMST itself, and in one of the two investigated hospitals. The non-improvement in drug availability in hospitals calls for further investigation in the future to understand the reasons for this. Key words: Central medical stores, Malawi, medicine availability, essential medicine, autonomous supply agency, pharmaceutical logistics, supply chain.